How Does Medicare Cover Telehealth?

As healthcare becomes a more tech-driven model, many Medicare beneficiaries are wondering how telehealth fits into their coverage. With the increasing prominence of telehealth, especially post-pandemic, it’s important to clarify what services are covered and how beneficiaries can best leverage these digital healthcare opportunities. Let’s dive deep into Medicare and telehealth in today’s digital age.

The Rise of Telehealth

Initially, telehealth coverage through Medicare was quite limited, focusing mainly on beneficiaries in rural areas. But telehealth became more prominent during the COVID-19 pandemic when many places shut down and people felt less comfortable going into doctors’ offices. This is even more true for Medicare beneficiaries who were at a higher risk. Legislative changes, especially in response to the pandemic, have expanded this coverage significantly for Medicare beneficiaries.

The benefits include:

  • Accessibility: For those in remote areas or people with mobility issues, telehealth bridges the gap.
  • Efficiency: Reduce the need for travel and waiting room times.
  • Safety: In situations like the COVID-19 pandemic, telehealth offers a way to consult with a physician without the risks of in-person visits.

What Services Can You Expect?

Prior to the pandemic, telehealth was limited to common office visits, psychotherapy, and some preventative screening. During the public health emergency telehealth services expanded to include:

  • Common office visits
  • Mental health counseling
  • Preventive health screenings
  • Physical and occupational therapy

Always remember that for a service to be considered a covered telehealth service, the healthcare provider must use an interactive 2-way telecommunications system.

Will Medicare stop covering Telehealth visits now that the COVID emergency has ended?

After December 31, 2024, if you are using Original Medicare, you must be at an office or medical facility located in a rural area (in the U.S.) for most telehealth services.

 You will still be able to get certain Medicare telehealth services without being in a rural health care setting, including:

  • Monthly End-Stage Renal Disease (ESRD) visits for home dialysis.
  • Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit.
  • Services to treat a substance use disorder or a co-occurring mental health disorder (sometimes called a “dual disorder”), or for the diagnosis, evaluation or treatment of a mental health disorder, including in your home.
  • Behavioral health services, including in your home.

Please Note:

Many Medicare Advantage Plans (MAPD) offer more telehealth benefits than Original Medicare. For example, these benefits might be available no matter where you’re located, and you might be able to get them at home instead of going to a health care facility. We can help you check your plan to find out what benefits it offers.

When is Telehealth Not Suitable?

While telehealth offers various advantages, there are scenarios where it may not be the best choice. Recognizing these situations ensures you receive optimal care.

  • Emergencies: Life-threatening conditions like heart attacks, strokes, or severe injuries require immediate medical attention and cannot be addressed adequately via telehealth.
  • Physical Examinations: Some medical situations necessitate a hands-on physical exam. Diagnosing certain conditions might require palpation, auscultation, or other direct examination methods.
  • Diagnostic Tests: If you need blood work, an X-ray, MRI, or other diagnostic tests, an in-person visit is unavoidable.
  • Limited Technology: Not all patients have access to high-speed internet or devices necessary for an effective telehealth session. Video quality is crucial for accurate consultations.
  • Privacy Concerns: If you’re in a space where you cannot speak freely or lack privacy, a telehealth visit might compromise your confidentiality.
  • Comfort Level: Some patients simply prefer face-to-face interaction, feeling it offers a more personalized approach.

Telehealth Costs with Medicare.

Telehealth services are covered under Part B of Original Medicare. This means if you only have Original Medicare, you will typically pay 20% of the Medicare-approved amount, and the Part B deductible applies. However, rates may differ if you have a Medicare Advantage plan (MAPD) and many MAPD plans have no copay for the visit.

How to Utilize Telehealth with Medicare

Under the current Medicare telehealth requirements, telehealth consultation requires both audio and video communication. Using smartphones for audio-only calls or without video is not allowed. Some services can be provided audio only if they are patient education or certain evaluation and management. However, the audio only option may expire with the end of the public health emergency.

Need assistance finding a plan that covers telehealth? Contact us here!


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